Minimally Invasive Procedure May Reduce Symptoms of Knee Osteoarthritis

A minimally invasive procedure may reduce symptoms of knee osteoarthritis, results of a German retrospective single-center study suggested.

In patients with moderate to severe knee osteoarthritis that didn’t respond to conservative treatments, quality-of-life and pain scores improved by 87% and 71%, respectively, at 1-year follow-up after receiving genicular artery embolization, reported Florian Nima Fleckenstein, MD, an interventional radiologist at Charité-University Hospital Berlin during the Radiological Society of North America annual meeting.

“Most patients say they experience rapid pain relief,” Fleckenstein said. “Remarkably, we achieved technical success in 100% of the procedures with no severe complications. Patients reported only minor side effects such as temporary skin discoloration and mild knee pain.”

Fleckenstein explained that genicular artery embolization involves blocking precise arteries that form a network around the knee joint. These vessels are altered in patients with osteoarthritis. Embolization of the abnormal blood vessels helps to disrupt the cycle of inflammation, cartilage destruction, and sensory nerve growth that characterizes osteoarthritis, he said.

“This study addresses osteoarthritis, which is a significant public health issue and the leading cause of chronic pain and disability worldwide,” he noted. “With millions of people affected by knee osteoarthritis, particularly in aging populations, finding effective, minimally invasive treatments is critical.”

“Our study found that genicular artery embolization can effectively reduce knee pain and improve quality of life early after the treatment, with these benefits being maintained over the long term, especially for people who haven’t had success with other treatments like physical therapy or pain medications,” he added. “This could potentially offer a new lease on life for many patients who suffer from debilitating pain and mobility issues caused by osteoarthritis.”

David Gimarc, MD, of the University of Colorado Anschutz Medical Campus in Aurora, told MedPage Today that “this procedure can certainly be offered as an option to knee replacement surgery for patients who have pain that is interfering with their activities of daily living. Clinicians in my practice do perform this procedure. This study gives us more information that shows the procedure is safe and effective.”

“The procedure can be performed quickly, and allows the patients to have a minimal recovery time, compared with knee replacement surgery. The relief is temporary but lasts several months or longer,” Gimarc said. “This procedure is not going to fix the problem caused by osteoarthritis, but it could put the decision on surgery farther down the road.”

He noted that the minimally invasive procedure can be repeated, if needed. “Fortunately the knee has multiple arteries that provide nutrition to the knee environment so the blocking of one or two of these blood vessels can be tolerated.”

However, Gimarc pointed out that reimbursement for the procedure varies among third-party payers. “Some of these companies consider the procedure to be experimental; others do cover it. These types of studies may help in getting more companies to accept it as an alternate treatment,” he said.

For this study, Fleckenstein and colleagues identified patients ages 40 to 90 who were diagnosed with moderate to severe knee osteoarthritis (Kellgren-Lawrence grade 2 to 4) that didn’t respond to conservative treatments. Median age was 69. Knee osteoarthritis severity was grade 2 in 12% of cases, grade 3 in 41%, and grade 4 in 47%.

Pain was assessed using the Visual Analog Scale and symptoms were measured using the Knee Injury and Osteoarthritis Outcome Score at baseline and during follow-up visits at 6 weeks, 3 months, 6 months, and 1 year.

After gaining femoral arterial access via a 4-Fr sheath, embolization was performed using imipenem/cilastatin. Target vessels were determined using digital subtraction angiography in correlation with the patients’ pain points